Overview
Guideline development has been undertaken in accordance with the standards prescribed by the National Health and Medical Research Council (NHMRC) under the direction of interdisciplinary expert advisory panels. All recommendations have been approved by the NHMRC.
As "living guidelines", recommendations are updated in near real-time as new evidence emerges, ensuring that clinicians always have access to the most current evidence-based guidance.
Key Methods
Priority Setting
Clinical questions are prioritised through stakeholder consultation, including surveys of Australian Rheumatology Association members to identify questions of highest clinical importance.
Systematic Evidence Review
We use a hierarchical approach, first seeking evidence from Cochrane and other high-quality systematic reviews, supplemented by forward searches for recent trials.
GRADE Assessment
Evidence certainty is assessed using the GRADE approach, evaluating risk of bias, precision, consistency, directness, and publication bias.
Expert Panel Review
An interdisciplinary panel including rheumatologists, other specialists, pharmacists, allied health professionals, methodologists, and consumers reviews evidence and formulates recommendations.
Evidence to Decision
Recommendations are developed using the GRADE Evidence to Decision framework, considering benefits and harms, certainty, values, resources, equity, acceptability, and feasibility.
Living Updates
Evidence searches are conducted quarterly. When new impactful evidence emerges, recommendations are updated and republished promptly.
Recommendation Strength
Recommendations are rated according to the GRADE methodology:
- Strong recommendation: Confident that the desirable effects of an intervention outweigh its undesirable effects (or vice versa for "against" recommendations)
- Conditional recommendation: Desirable effects probably outweigh the undesirable effects, but appreciable uncertainty exists
All current recommendations in these guidelines are conditional, reflecting the complexity of treatment decisions in inflammatory arthritis and the importance of shared decision-making with patients.
Living Guideline Process
Evidence searches underpinning living recommendations are updated every three months. Where new and impactful evidence emerges, a new version of a recommendation will be published. Changes may involve updates to the recommendation itself and/or to the supporting text.
When certainty underpinning a recommendation is high and unlikely to change, it may be retired from "living mode" with annual evidence searches instead.
For full details of how GRADE is used for developing clinical recommendations, refer to the GRADE Handbook.
Reports & Documentation
Full details of our methods, evidence summaries, and search strategies are available in our technical documentation: